Provider Demographics
NPI:1649664863
Name:BUTLER, JASPERA VICTORIA (LPCA)
Entity type:Individual
Prefix:
First Name:JASPERA
Middle Name:VICTORIA
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E MARKET ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-3980
Mailing Address - Country:US
Mailing Address - Phone:919-934-1062
Mailing Address - Fax:919-934-1063
Practice Address - Street 1:130 COMMERCE PKWY
Practice Address - Street 2:SUITE 111
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7966
Practice Address - Country:US
Practice Address - Phone:919-772-1990
Practice Address - Fax:919-772-1978
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10168101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional